No reduction in HIV levels in men who have sex with men despite a decade of prevention work
Despite a significant increase in HIV testing and treatment, the number of new HIV infections in men who have sex with men (MSM) has remained unchanged over the last 10 years in England and Wales, according to a new study by the Medical Research Council (MRC) and Health Protection Agency (HPA). The research also reports undiagnosed HIV infections remained high and annual new diagnoses rose steadily from 2001-2010. These results show that HIV transmission amongst MSM remains a significant public health issue.
Dr Daniela De Angelis, lead investigator at the MRC Biostatistics Unit, comments:
“Unlike previous publications, our modelling approach was used to disentangle the competing contributions of increased rates of diagnosis of existing HIV infections and of HIV incidence (new infections) to observed HIV diagnoses in MSM. By applying the model to the latest surveillance data we were able to provide a comprehensive picture of the HIV epidemic amongst MSM in England and Wales over the past 10 years”.
Published in Lancet Infectious Diseases, the research found no evidence of a decline in levels of HIV over the last decade, with new infections plateauing at 2,300–2,500 annually from 2006 onwards. Undiagnosed HIV infections in MSM increased from 7,370 in 2001 to 7,690 in 2010. Despite a 20 per cent reduction in the average time between infection and diagnosis, from 4 years to 3.2 years, 38 per cent of infections in 2010 were still diagnosed after the time patients should have started antiretroviral (ARV) treatment.
Analysing additional HPA surveillance data from the same period, the authors found these trends occurred despite the fact that MSM HIV testing had increased by 3.7 times to 59,300 STI clinic tests per year in 2010, and that the proportion of MSM receiving HIV care had risen from 69 per cent to 80 per cent) with a greater proportion of MSM eligible for ARV treatment accessing it (from 75 per cent to 84 per cent).
Dr Valerie Delpech, HPA head of HIV surveillance, said:
“We are seriously concerned about the level of ongoing HIV transmission and the significant impact this is having within the MSM community. The most plausible explanation for these results is continuing unsafe sexual behaviour coupled with insufficient HIV testing, showing us just how vital safe sex programmes engaging MSM remain.
“MSM should get an HIV and STI screen at least annually, and every three months if having unprotected sex with new or casual partners – and we urge clinicians to take every opportunity to offer the test to this group. By coupling earlier and more frequent testing with programmes that reduce unsafe sexual behaviour in MSM, whilst maintaining high levels of treatment and retention in care, we could substantially reduce HIV transmission.”
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Notes to editors
Nearly one in 12 MSM in London and one in 20 in the UK now have HIV (47 per 1,000). MSM can reduce their risk of getting or transmitting HIV, or a sexually transmitted infection, by:
- Always using a condom correctly and consistently when having sex with new or casual partners, until all partners have had a sexual health screen.
- Avoiding overlapping sexual relationships and reduce the number of sexual partners.
- Getting an HIV and STI screen at least annually, and every three months if having unprotected sex with new or casual partners
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